分次手术切除巨大汗孔角化症1例

A case of surgical excision of giant porokeratosis

报告分次手术切除巨大汗孔角化症1例。患者男,54岁,因右上腹部紫红色斑伴瘙痒29年就诊。皮肤科情况:右上腹可见一直径约15 cm大小类圆形紫红色斑片,境界清楚,表面角化粗糙,附有少许鳞屑,周围呈褐色,无明显隆起,无糜烂、渗出。皮损组织病理:板状层角化过度,见一角化不全柱,其下方表皮无颗粒层,见数个角化不良细胞,余表皮棘层不规则增厚,真皮浅层血管扩张,管周少量或中等量单一核细胞浸润,间有噬色素细胞。皮肤镜检查:暗红背景,界限清,边缘可见白色轨道征及线状血管,中央可见灶状色素减退,弥漫线状血管及逗号样血管,周围可见增厚性黄色鳞屑。诊断:Mibelli型汗孔角化症。采取分次切除的方法分4次将皮损切除,术后皮损愈合较好,随访1年,无复发。

To report a case of staged surgical excision of giant porokeratosis.A 54-year-old man had been seeking medical attention for 29 years due to an itchy purplish-red spot on the right upper abdomen.Dermatological examination revealed a well-defined round purplish-red patch,approximately 15 cm×15 cm,with rough keratinization and few attached scales on the surface.Brown color was observed around the lesion without any noticeable elevation,erosion or exudation.Histopathological analysis showed hyperkeratosis and parakeratosis,loss of granular layers,irregular thickening of the stratum spinosum,superficial dermal vasodilation and perivascular infiltration of mononucleated cells along with melanophages.Dermoscopy revealed dark red background with clear boundaries,whitish peripheral rim and linear vessels,focal hypopigmentation,comma-like vessels at center,as well as thickened yellow scales in the surrounding area.Diagnosis was porokeratosis of Mibelli.The skin lesion was surgically removed using a staged excision method over four stages,resulting in successful healing without recurrence during one-year follow-up.